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Our Returning Soldiers and Constrictive Bronchiolitis.

Too many of our returning soldiers have it – the Agent Orange of
2010 – lung disease leading to the good, the bad and the ugly.

The only thing “good” about the following is that it is bringing
public attention to an invisible disease and the 4th leading cause
of death in the nation, killing 120,000 people a year. COPD is
expected to be the 3rd leading cause of death by 2020.

The “bad” is our soldiers were hit by the invisible permanent
lung damage of constrictive bronchiolitis.

“…In 2008, Miller and pulmonary/critical care fellow, Matthew
King, M.D., pulled together the first round of what they believe is
solid evidence that soldiers are returning with serious and
permanent lung injuries related to their service….”

“…The soldiers also shared similar stories of exposure in Iraq
to massive amounts of smoke from sulfur fires in 2003, or breathing
air fouled by sand and smoke from burn pits all over the country.
Miller made a… “unconventional” move and recommended surgical
biopsies.

“So far, all but a few of these soldiers we have biopsied have
had constrictive bronchiolitis,” Miller said…”

The ‘ugly’ is that our soldiers and nation are faced with 2010’s
version of ‘Agent Orange.

“… typical example of what may be an emerging profile: a soldier
who was fit, a lifelong non-smoker, and who returned from
deployment in Iraq with permanent lung damage.

Since 2004, physicians serving the Fort Campbell Army base have
been referring dozens of soldiers with exercise-induced shortness
of breath to Vanderbilt, to see Robert Miller, M.D., associate
professor of Allergy, Pulmonary and Critical Care Medicine. “

“The soldiers also shared similar stories of exposure in Iraq to
massive amounts of smoke from sulfur fires in 2003, or breathing
air fouled by sand and smoke from burn pits all over the
country.

Miller began to wonder if conventional testing might not be
enough. He made what he calls an “unconventional” move and
recommended surgical biopsies.

“So far, all but a few of these soldiers we have biopsied have
had constrictive bronchiolitis,” Miller said.

Constrictive bronchiolitis, also called Bronchiolitis
Obliterans, is a narrowing of the tiniest and deepest airways of
the lungs.

It is rare, and can only be diagnosed through biopsy. Cases that
have been documented in the medical literature show striking
similarities to what is seen in the soldier’s biopsies.

“These are inhalation injuries, suffered in the line of duty,”
said Miller.

In 2008, Miller and pulmonary/critical care fellow, Matthew
King, M.D., pulled together the first round of what they believe is
solid evidence that soldiers are returning with serious and
permanent lung injuries related to their service.

Most of the first patients biopsied were 101st Airborne soldiers
who fought the Mishraq Sulfur Mine fires in 2003. Later, many
soldiers reported exposure to burn pits, especially a massive,
10-acre burn pit in Balad, Iraq….”

Deployment in Mosul renders a former marathon runner and mom of
7-year-old daughters “unable to pass her military physical fitness
testing.”

“The former marathon runner and mother of 7-year-old twin
daughters returned from deployment in Mosul in 2007 unable to pass
her military physical fitness testing. Even her colleagues at the
Army hospital couldn’t help her pinpoint what was wrong.

When Waters heard about Miller’s work she came to Vanderbilt in
2008. Her biopsy confirmed constrictive bronchiolitis.

“As a medical officer, I am considered fit for duty because I
can still work in the O.R., even if it is only one day per week,”
Waters said. “But my future is uncertain. Once I leave the service
it could be very difficult to get medical coverage because of my
preexisting medical condition.”

Miller says he is concerned soldiers continue to be tested for
shortness of breath across the country using only conventional
methods.

He says surgical biopsy and definitive diagnosis are required
just to create the possibility of proper compensation, but even
then, there is no guarantee.
“Even with positive biopsy, disability ratings have been highly
variable,” Miller said.”

http://www.mc.vanderbilt.edu/reporter/index.html?ID=8270

Thanks to the bright, thinking and unconventional medical folks
approach at Vanderbilt and elsewhere, Chronic Obstructive Pulmonary
Disease (COPD) is beginning to see the light of day.

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About This Blog

This is a patient to patient blog to exchange information and resources...from COPD (Chronic Obstructive Pulmonary Disease) to Arthritis to Cellulites to Sarcoidosis to Sleep Apnea to RLS to Psoriasis to Support Groups to Caregivers and all points in between. Written by Sharon O'Hara.